At the end of last month, UK Prime Minister Gordon Brown and Ministers from both the developed and developing world launched a new International Health Partnership (IHP) designed to "achieve the Health Millennium Development Goals." The IHP will aim to improve health systems, create better coordination amongst donors, and improve developing countries' own health plans. There is reference to reproductive health in the IHP agreements, but predictably it remains a mention rather than a strong commitment.
"It is a pity that reproductive health is not explicitly mentioned as a prime target [in the IHP]," says Tony Worthington, a Minister in the Blair Government and a leading member of the Government's Select Committee on International Development. "Coordination is important, but so is courage. The lack of courage in putting reproductive health at the center of the Millennium Development Goals has lessened the fight against infant and maternal deaths and deepened poverty."
Worthington, who is now Chair of the Safe Hands For Motherhood NGO, argues that good reproductive health – including action to prevent HIV/AIDS – is the central building block of good health. "We have not said that because others are afraid of the truth and it has cost the poor dearly. This new partnership should start by returning to another international health partnership, the pledges of the Cairo Conference in 1994 and honoring them. We would then see that this IHP is not just words," he says.
The International Planned Parenthood Federation agrees that health systems do need to be strengthened and that there is an urgent need for greater harmonization by donor agencies. However, IPPF also believes a focus on all aspects of maternal health, including sexual and reproductive health and rights, is vital if the Millennium Development Goals are to be reached, and remains concerned that there is only one mention of reproductive health in the IHP agreement.
"We are concerned that areas of public health that are considered controversial in some countries, such as unsafe abortion, will be neglected unless sufficient focus is placed upon these issues by donor agencies and recipient countries. Likewise, we remain concerned that the role of civil society in the IHP has and continues to be at the margins of the negotiations and discussions," said an IPPF spokesperson.
"In terms of support to reproductive health, show me the plans with these [reproductive health] issues well articulated and linked to nationally agreed Mid Term Expenditure Frameworks and comprehensive monitoring and evaluation frameworks both targeting the poor – then I will think this new IHP will effect change," says one international health systems expert.
These three perspectives from a politician, the world's largest reproductive health NGO, and a health systems expert suggest it will be a hard struggle to promote reproductive health in the IHP. Another missed opportunity? Or perhaps an oversight, which could be redressed with some hard lobbying as the IHP rolls forwards?